Healthcare Provider Details

I. General information

NPI: 1053537910
Provider Name (Legal Business Name): PETER MICHAEL RYDESKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/25/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

PO BOX 750243
FLINT OH
48532-5407
US

V. Phone/Fax

Practice location:
  • Phone: 937-709-5051
  • Fax: 937-709-5050
Mailing address:
  • Phone: 937-709-5051
  • Fax: 937-709-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301084393
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: